Possibilities of multi-ingredient therapy in the management of patients with metabolic dysfunction-associated steatоtic liver disease and type 2 diabetes mellitus

Objective — to evaluate the efficacy and safety of multi‑ingredient complex therapy in patients with metabolic dysfunction‑associated steatоtic liver disease (MASLD) with type 2 diabetes mellitus (DM‑2) using S‑adenosylmethionine with glutathione. Materials and methods. We conducted a multicenter randomized prospective comparative study in parallel groups to investigate the efficacy and safety of the drug Hepavista Detox, containing 400 mg of S‑adenosylmethionine and 250 mg of glutathione. 91 patients (51 men and 40 women) aged 39 to 75 years were observed. They were divided into two groups: the main group, comprising 61 patients (35 men and 26 women) with a combination of MASLD and DM‑2, and the comparison group including 30 patients (16 men and 14 women) with DM2 without MASLD. The control group consisted of 30 practically healthy volunteers (16 men and 14 women aged 28—59 years) who had no complaints from the gastrointestinal tract, in whom MASLD and DM‑2 were excluded during a comprehensive examination. All patients underwent a comprehensive clinical, biochemical and ultrasound examination, anthropometric examination with calculation of body mass index (BMI) and HOMA‑IR index (Homeostatic Model Assessment). The diagnosis of MASLD was made based on the presence of DM‑2 and sonographic signs of steatosis and the degree of its severity (with steatometry), biochemical signs of steatohepatitis (increased activity of liver enzymes). Results. MASLD, along with overweight and obesity, is often found in patients with DM‑2 and may be one of the predictors of a decompensated course of DM‑2. Steatohepatitis was detected in 41.0% of MASLD patients with DM‑2, and steatosis in — 59.0%. In the presence of MASLD in patients with DM‑2, not only cytolysis markers increase, but also lipid and carbohydrate metabolism indicators significantly worsen, which allows us to consider MASLD as a factor in the progression of DM‑2. All MASLD patients with DM‑2 were diagnosed with steatosis before treatment, and 57.4% had liver fibrosis. Conclusions. The use of multi‑ingredient therapy with “Hepavista detox” in patients with MASLD and DM‑2 is pathogenetically directed, effective, and safe. After a three‑month course of Hepavista detox, patients had normalized the levels of liver enzymes (alanine aminotransferases, aspartate aminotransferases, glutamyl transpeptidases), a tendency to reduce insulin resistance with a decrease in the HOMA‑IR index, stabilization of lipid metabolism with an increase in high‑density lipoprotein cholesterol, a decrease in the ultrasound attenuation coefficient and a decrease in the intensity of liver steatosis. This allows us to recommend Hepavista detox for the treatment of patients with MASLD with type 2 diabetes mellitus.